1. Field of Invention
This invention relates to hospital emergency carts, in particular to carts which contain medications and devices for use in life-threatening conditions.
2. Prior Art
In U.S. Pat. No. 6,116,461 (2000), Broadfield et al. teach a system and apparatus in which modular receptacles are filled with medications and transported to automatic dispensing machines for later retrieval and distribution. Memory chips, associated with a computer, store and maintain information about the contents of each receptacle, such as expiration dates of drugs and the like. An inventory of the receptacles"" contents is automatically maintained as users access each receptacle.
In U.S. Pat. No. 6,011,999 (2000), Holmes teaches a dispensing apparatus for controlled dispensing of pharmaceutical and medical supplies which includes a cabinet having a plurality of drawers, each containing a plurality of receptacles. The receptacles have lockable lids which are unlocked under the control of an electronic processor. The processor prevents access to contents of the receptacles by unauthorized personnel. It also keeps an inventory of the contents of the cabinet.
Pearson, in U.S. Pat. No. 5,292,029 (1994), teaches a dispensing system in a mobile cart. The cart comprises a plurality of containers containing doctor-prescribed medications for individual patients. To dispense medication, a nurse enters a patient ID code into a microprocessor program, the program causes the microprocessor to actuate a mechanism which releases secured medication-dispensing units on the cart. The microprocessor records the time, date, and quantity of medication dispensed.
While each of these systems provides for the secure transport and delivery of medications, none provides a check or alarm against the possible misapplication or mistaken prescription of a drug. Further, none provides a check against established standards for dispensing of medications and apparatus, especially during a life-threatening emergency. Still further, none provides patient diagnostic feedback and guidance during a medical emergency.
When respiratory and circulatory processes are interrupted, prompt treatment directly correlates with optimal outcome for successful revival and minimization of neurological damage to the patient. In the past in hospitals, clinics, and some paramedic units, the traditional xe2x80x9ccode cartxe2x80x9d came into use. The cart carries equipment needed to monitor activity of the heart, emergency medications, electrical defibrillator, and supplies and apparatus necessary to maintain respiratory function. Drawers in the cart typically contain supplies such as intravenous equipment, syringes, supplies for airway management, an electrocardiograph (EKG), a defibrillator equipped with EKG capability for cardioversion, and the like. The placement of supplies and equipment in a code cart often vary from one medical facility to another.
The cart is normally wheeled to a patient who is in a life-threatening medical condition, usually referred to as a xe2x80x9ccodexe2x80x9d. A group of hospital personnel remove various items from the cart as they are needed and administer them to the patient, usually under the direction of one person, i.e. a physician, who leads the code. This person calls out the recommended xe2x80x9cinterventionsxe2x80x9d that are needed at any point during the code. One member of the code team, the recorder, observes the code as it progresses and records all events related to the code. Other code team members identify and manage airway problems, give Cardio-Pulmonary Resuscitation (CPR) if required, maintain an intravenous (IV) site, and administer medications.
In the United States, codes are typically conducted according to the most recent Advanced Cardiac Life Support guidelines for standard care, issued by the American Heart Association. These guidelines are furnished in the form of algorithms. Each algorithm proceeds along established pathways of treatment for varied dysrhythmias, such as tachycardia, as the patient""s clinical condition is affected. Numerous other algorithms exist, including the Asystole Treatment Algorithm, Bradycardia and Heart Block Algorithm, and the like. These algorithms apply to adults. Another group of algorithms applies to children, to address emergencies pertaining to pediatric patients.
At the start of a code, the proper algorithm is determined and may be used as a guide during the code. More than one algorithm may be used during the code, according to the patients"" condition. At present, these guidelines are in written form, and also memorized by Advanced Cardiac Life Support (ACLS) caregivers as part of an over-all educational program.
The prior-art cart is adequate to convey medicines and apparatus to the patient. However, care of the patient is provided by a group of individuals. In this group effort, which is normally highly stressful for all concerned, it is possible for the correct focus of the code to be lost. For example, a medication may be removed form the cart and not given, given more than once, given at the wrong time, or otherwise be contraindicated.
Because of the rapid pace at which numerous events occur, the level of stress, the complicated nature of the work in progress, and the large volume of information which must be recorded, the recorder may have difficulty documenting the scenario accurately. For later examination of the recorder""s record, it is important to note the time at which events occurred relative to the patient""s condition. For example, the patient""s heart rate or the quality of their pulse may change in response to an intervention. The timing of these and other events is essential in the proper documentation of the code. Due to the high volume of writing required in a short period of time, the margin of error in documentation is high. The recorder has several timepieces to choose from: a watch, a clock on the wall, the time stamp on an EKG record, and the like. If possible, a single source of the time of day should be used since all these sources will likely vary by several minutes. For example, the EKG monitor displays the time of its inner clock. If this is the official time record, then the reporter should use it to indicate the timing of drug deliveries which is generally different from other time sources available, such as a wrist watch or clock on the wall. However, the EKG record is often printed after the code, which makes it difficult or impossible to coordinate with the recorder""s watch.
The overall effect is that prior-art carts being utilized today leave a large margin for human error in administering the appropriate treatment or medications, thus increasing the margin for injury to patients and the medical team. Medications are generally supplied in boxed packages containing glass vials or syringes with needles. These can be awkward and hazardous to assemble. In addition, the location of these items varies from one code cart to another, making it difficult to find them. This adds to the stress experienced by code personnel, increasing the risk of accidents during a code. This inefficient system contributes to slower response times in delivery of care.
Accordingly, several objects and advantages of the invention are to provide an improved medical code cart system for dispensing medicines and medical equipment, with the addition of a check system of medications and equipment prior to use, to act as a safety mechanism for appropriateness for use. Other objects are to provide a computerized system which reduces human error, maintains a running inventory of the contents of the cart, provides information to a facility""s restocking and billing departments, contains its own internal clock and calculator, optionally provides visible and audible alarms appropriate to various unsafe conditions, and provides diagnostic interplay with code team users to promote speed and accuracy in delivery of patient care. Further objects and advantages will become apparent from a consideration of the ensuing description and the accompanying drawings.
In accordance with the present invention, a computerized cart and method are provided which are programmed with Advanced Cardiac Life Support (ACLS) and perhaps additional algorithms to act as a guide throughout a given code. The cart""s computer contains a calculator function for computing dosage amounts of medications, based on the patient""s weight. Its programming also contains a continual diagnostic electrocardiogram function which will aid in the identification of shockable rhythms or ones requiring external pacing. Inputs are also provided from patient data by ancillary monitoring equipment, including ongoing blood pressure monitoring, and other diagnostic equipment. Subjective data on the patient""s condition is logged in by the team recorder. The cart""s computer analyzes and records data from these sources and provides guidance through the code algorithm, issuing alarms and making suggestions when appropriate. All information about the code is displayed on the computer""s monitor screen. A permanent record of progress through the code is maintained, indicating the withdrawal of items from the cart, the times at which interventions occur, and the resulting condition of the patient, as evidenced by EKG, oximeter, blood pressure, and other readings. This record can be downloaded from the computer, saved to disk, and printed.
The contents of the cart are organized in a manner which reflects current ACLS guidelines drawer by drawer, in a left-to-right fashion. When the drawer for a code algorithm is opened, electrical switches detect the removal of medications and medical equipment from the cart and convey this information to the cart""s computer for entry into a permanent record. A button associated with each medication is pressed as the medication is given to the patient. This information is also entered into the record by the cart""s computer. If a medication or intervention which is not indicated by the algorithm is withdrawn from the cart, the cart""s computer provides a visual or audible alarm, or both, to alert the individuals conducting the code that the algorithm is not being followed. The system also prompts the code team, suggesting certain actions as appropriate, based on the current algorithm and the patient""s condition without locking out the physician""s choice of action. All interventions, recommended or not or done by a physician""s choice are recorded. The individuals conducting the code can still give the medication in question, and its administration will be logged by the recorder. Pre-mixed or easy-to-mix medications are packaged ready-for-use. Needle-less syringes contain predetermined quantities of medications.